Provider Demographics
NPI:1073584710
Name:BLANCO, CHRISTOPHER JOHN (DPM)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:JOHN
Last Name:BLANCO
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:8053 NW 114TH PATH
Mailing Address - Street 2:
Mailing Address - City:MEDLEY
Mailing Address - State:FL
Mailing Address - Zip Code:33178-2510
Mailing Address - Country:US
Mailing Address - Phone:786-953-4466
Mailing Address - Fax:
Practice Address - Street 1:701 NW 57TH AVE
Practice Address - Street 2:320
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33126-2072
Practice Address - Country:US
Practice Address - Phone:305-264-2632
Practice Address - Fax:305-266-2274
Is Sole Proprietor?:No
Enumeration Date:2006-01-31
Last Update Date:2010-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO 3186213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL313984OtherAVMED
FL65926OtherBLUECROSS BLUE SHIELDS
TN204445857OtherCIGNA
FL340554100Medicaid
FL7060825OtherAETNA
FL2700492OtherUNITED HEALTH CARE
FL340554100Medicaid
FL7060825OtherAETNA